title: Effectiveness of hospital-based postpartum procedures on pertussis vaccination among postpartum women.
abstract: OBJECTIVE
  Pertussis causes significant morbidity among adults, children, and especially infants. Since 2006, pertussis vaccination has been recommended for women after delivery. We conducted a prospective, controlled evaluation of in-hospital postpartum pertussis vaccination of birth mothers from October 2009 through July 2010 to evaluate the effectiveness of hospital-based procedures in increasing postpartum vaccination.
  
  
  METHODS
  The intervention and comparison hospitals are private community facilities, each with 2000-6000 births/year. At the intervention hospital, physician opt-in orders for tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) before discharge were implemented in November 2009, followed by standing orders in February 2010. The comparison hospital maintained standard practice. Randomly selected hospital charts of women after delivery were reviewed for receipt of Tdap and demographic data. We evaluated postpartum Tdap vaccination rates and conducted multivariate analyses to evaluate characteristics that are associated with vaccination. We reviewed 1264 charts (658 intervention hospital; 606 comparison hospital) from women with completed deliveries.
  
  
  RESULTS
  Tdap postpartum vaccination was 0% at both hospitals at baseline. In the intervention hospital, the introduction of the opt-in order was followed by an increase in postpartum vaccination to 18%. The introduction of the standing order approach was followed by a further increase to 69% (P < .0001). No postpartum Tdap vaccinations were documented in the comparison hospital. Postpartum Tdap vaccination in the intervention hospital did not differ by demographic characteristics.
  
  
  CONCLUSIONS
  In-hospital ordering procedures substantially increased Tdap vaccination coverage in women after delivery. Opt-in orders increased coverage that increased substantially with standing orders.
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA and David Geffen School of Medicine at UCLA, Torrance, CA. Electronic address: syeh@labiomed.org.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Yeh
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA and David Geffen School of Medicine at UCLA, Torrance, CA.
authors.forename: ChrisAnna
authors.initials: C
authors.lastname: Mink
authors.affiliation: Department of Obstetrics and Gynecology, Cedars Sinai Medical Center and David Geffen School of Medicine, University of California, Los Angeles, CA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Perinatal Medicine, Providence Little Company of Mary Hospital, Torrance, CA.
authors.forename: Scott
authors.initials: S
authors.lastname: Naylor
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA and David Geffen School of Medicine at UCLA, Torrance, CA.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Zangwill
authors.affiliation: Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Norma J
authors.initials: NJ
authors.lastname: Allred
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010567:Pertussis Vaccine; D049590:Postpartum Period; D011446:Prospective Studies; D016896:Treatment Outcome; D014611:Vaccination; D014917:Whooping Cough / Q000517:prevention & control*
chemical_list: D010567:Pertussis Vaccine
keywords: Tdap; opt-in; postpartum; standing orders; vaccination